Assistant Professor, Attending Physician University of Oklahoma Health Sciences Center OU Health Sciences Center Edmond, Oklahoma, United States
Background: Buprenorphine is an opiate partial agonist, used in the management of addiction and chronic pain. Its increasing prevalence has posed a risk to children through inadvertent exposures.
Significant variability exists regarding dose-related effects for opioid ingestions in children. Exposures may result in lethargy, respiratory depression or death. There are no evidence-based triage criteria to guide treatment. Review of the epidemiology of buprenorphine ingestion is necessary to guide intervention.
Objective: Goals for this study were to characterize the frequency of buprenorphine ingestion in young children with description of demographics, dosing, management and clinical outcomes.
Design/Methods: A retrospective analysis of buprenorphine exposures in pediatric patients ≤ 5 years of age using data from Toxicall®, the electronic medical database used by the Oklahoma Center for Poison and Drug Information, in conjunction with a chart review of buprenorphine exposures presenting to the emergency department at of the University of Oklahoma Health Sciences Center (OUHSC), Children’s Hospital between January 1, 2015 and December 31, 2019 was conducted. Descriptive statistics summarize demographic and clinical outcomes.
Results: Toxicall® analysis revealed one hundred and one (101) patients treated for buprenorphine ingestion in Oklahoma. Eighty-five (85) were treated at hospitals outside OUHSC. Seventeen (17) of those required naloxone therapy, ten (10) of which required continuous naloxone drips.
A sixteen (16) patient subset of the total were treated at emergency department at The OUHSC Children’s Hospital and analyzed by chart review. Twelve (12) patients required admission for treatment and/or observation. Eight (8) admitted patients required naloxone, three (3) of which required continuous naloxone infusion. Duration of effects for those admitted to OUHSC ranged from 8 to 72 hours. Patients seen at non-pediatric ED's received naloxone treatment less often.
The amount of buprenorphine ingested could not always be established. One patient requiring continuous naloxone infusion ingested only 0.26 mg/kg buprenorphine. There were no fatalities in any of the 101 patients. Conclusion(s): Significant morbidity was found among victims of buprenorphine ingestion. 27.7% of patients required naloxone therapy. Approximately 10% of patients required naloxone drips. The development of evidenced-based triage criteria to guide management will require larger patient datasets.
SIGNS AND SYMPTOMS
Naloxone Treatment in Buprenorphine Ingestion
Subset of sixteen (16) patients treated at OUHSC Children's Hospital.
Authors/Institutions: Robert D. Johnson, OU Health Sciences Center, Oklahoma City, Oklahoma, United States; Ryan S. McKee, OU Health Sciences Center, Oklahoma City, Oklahoma, United States; Jami Johnson, Oklahoma Center for Poison & Drug Information, Oklahoma CIty, Oklahoma, United States